Vol. 31 No. 2 June 2019
Combined Multi-segmental Surgical-orthodontic Treatment in Skeletal Class III with Facial Asymmetry and Gummy Smile: Two-year Stability
Rouh-Hwai Wang, Hui-Ling Chen
This is a case of skeletal class III malocclusion with facial asymmetry, gummy smile, and maxillary canting, treated with bimaxillary surgery and orthodontic treatment. The two-jaw surgery was performed including a 3-pieces LeFort I segmental osteotomy, anterior segment impaction with clockwise rotation, and bilateral sagittal split osteotomies with genioplasty. Through the 2-year-4-month treatment procedure, the skeletal and occlusal relationship turned to be normal with esthetically pleasing smile and profile. Furthermore, in the two-year follow-up, we found the treatment results were quite stable no matter in skeletal or dental aspects.
Vol. 31 No. 2 June 2019
A Modified Surgery-first Approach for Mandibular Prognathism with Proclined Maxillary Incisor and Mandibular Spacing
Jutharath Chanruangvanich, Ellen Wen-Ching Ko, Ying-An Chen
This case report describes the management of an adult patient presenting with a skeletal Class III malocclusion, mandibular protrusion, upper incisor proclination and mandibular arch spacing by a modified surgery-first approach. A 26-year-old man had skeletal Class III and dental Class III malocclusion with concave facial profile, midface deficiency and mandibular prognathism with chin deviation to left. His dental manifestation presented anterior crossbite, upper incisors proclination and spacing in his mandibular arch. Treatment was performed with a modified surgery-first approach, which included a short presurgical alignment phase. In the maxilla, the significant maxillary crowding was relieved by 14 and 24 extractions while partially retracting the maxillary incisors to reduce the incisal proclination. Then, the upper incisors inclination was furtherly corrected more by a 2-pieces LeFort I osteotomy and closure of the 14, 24 residual dental space during surgery. In the mandible, the lower dental spacing was caused by general tooth size/ jaw bone discrepancy with relative upright incisal inclination. The presurgical preparation included consolidation the dental space distal to the bilateral mandibular canines. The bilateral sagittal split osteotomies were conducted for mandible setback and asymmetry correction. Additionally, the subapical osteotomy with Köle procedure was applied to close the dental space in the mandibular arch while keeping the anterior teeth in relative normal inclination. The excessive chin prominence caused by the Köle procedure was reduced by reduction genioplasty and surface contouring. Post-operative orthodontic treatment included overbite control and detailing of the occlusion. After treatment, the maxillary incisors proclination was corrected and all the dental spaces were closed. Patient’s profile was dramatically improved with well teeth alignment, angulation and interdigitation. The 2-pieces LeFort I and Köle osteotomy are the surgical procedures to address the correction in the dentoalveolar portion for efficiently control the inclination of the anterior teeth. Moreover, it also provides benefits for patients who require large amount of jaw setback with minimal effect at the posterior airway space. The treatment goals of the dentoalveolar portion and facial proportion should be contemplated for the staged procedures to improve the efficiency and effectiveness of the treatment outcome.
Vol. 31 No. 2 June 2019
Orthodontic Treatment of Class II Malocclusion with Single Maxillary Incisor
Chien-cheng Chen, Yi-horng Chen
Orthodontic treatment of a Class II malocclusion case with single maxillary central incisor was presented in the case report. The treatment plan consisted of removing one maxillary central incisor instead of premolars. Bilateral maxillary lateral incisors were mesialized for space closure and substitution for maxillary central incisors. The morphology of maxillary lateral incisors was modified to mimic the maxillary central incisors. After treatment, both occlusion and esthetics was improved, and the patient was satisfied with the results.
Vol. 31 No. 2 June 2019
To do or not to do? Slow orthodontic extrusion for implant site development in esthetic zone at the anterior maxilla
Hui-chen Tasi, Chung-Chen Jane Yao,2, 3 Cheing-Meei Liu1, 3
Slow orthodontic extrusion (SOE) for implant site development, was introduced in 1991. It has been more than 20 years since this treatment was applied in our clinical practice. In this paper, we investigate surgeon’s expectation of SOE for special requirements of immediate implantation by a clinical case. We also review case reports/case series searched from PubMed and inspect the power of evidence of these reports from the integration of data collection, and try to define the value of SOE. If the SOE cannot eliminate at least one surgical procedure, we need to consider the necessity of SOE before implant surgery.
Vol. 31 No. 2 June 2019
Orthodontic Correction of Bimaxillary Protrusion with Mini-screws in Class II Hyperdivergent Patient
Shih-Ying Lin, Kai-Wen Yu, Tai-ting Lai, Chung-Ji Liu, Li-Fang Hsu
To achieve a harmonious profile with pleasant smile arc in Class II hyperdivergent adult cases has been a clinical challenge. Adequate retraction and intrusion of maxillary dentition as well as vertical control are the key factors to improve the smiling appearance and the facial profile. A 19-year-old female initially presented with lip protrusion, convex profile, retrusive chin, and a Class II malocclusion. The cephalometric analysis showed a Class II skeletal pattern (ANB = 9°) with high mandibular plane angle (SN-MP = 38°). The treatment plan included extraction of four first premolars for anterior teeth retraction as well as installation of three miniscrews in the maxilla as bony anchorage. Two miniscrews were placed into the infrazygomatic crest of the maxilla and one was inserted in the sub-apical region of maxillary incisors for retraction, intrusion, and torque control of anterior teeth. Bimaxillary protrusion was improved and a stable occlusal relationship was established after treatment. The total treatment duration was 24 months. Cephalometric analysis showed significant intrusion and retraction of maxillary incisors as well as a slight counterclockwise rotation of the mandible. This case demonstrated that the combined use of upper posterior and anterior miniscrews could be an effective manner to treat Class II hyperdivergent adult case with dentoalveolar protrusion.
Vol.31-1-1 March 2019
Diagnosis and Management of Impacted Maxillary Canines
Yu-Cheng Hsu, Chia-Tze Kao, Chih-Chen Chou, Wen-Ken Tai, Po-Yu Yang
Maxillary canines play an important role in facial esthetics, since the canine eminence can support the alar and the upper lip. Impacted maxillary canines is a common problem which requires multidisciplinary diagnosis and treatment in dental clinic. The aim of this review is to integrate the studies that include clinical diagnosis and guidelines for management of canine impaction.
Vol.31-1-2 March 2019
Accuracy of Different Sequencing in Bimaxillary Orthognathic Surgery: A Systematic Review and Meta-analysis
Thatchawee Borikanphanitphaisan, Ellen Wen-Ching Ko
Introduction: Compared to the classic maxilla-first sequence in bimaxillary orthognathic surgery,
inverted mandible-sequence has been encouraged for potentially higher accuracy. However, evidence regarding
this topic is lacking. Methods: A systematic review of the literature on different sequencing of bimaxillary
surgery was conducted, gathering from following databases: Cochrane, Pubmed, Scopus, Medline (Ovid),
Web of Science, ScienceDirect. Articles mentioning “sequencing”, “mandible-first”, “orthognathic surgery”
of at least case-report level of evidence were included without restriction. Relevant articles were included
for quality assessment and extracted data for indications of mandible-first sequence from all studies. Metaanalysis of surgical accuracy at upper central incisors in horizontal and vertical dimension was performed from
included experimental studies. Results: The search of initially 619 articles resulted in 9 final articles: 6 case
reports and 3 experimental studies. The four most commonly listed indications for mandible-first approach
included instability of condylar centric relation (CR) position, posterior maxillary downgrafting, when rigid
fixation of maxilla cannot be ascertained, and large maxillomandibular advancements. The pooled analysis of
experimental studies composed of 188 patients (122 females, 66 males). Quality assessment of these studies
resulted as moderate. Meta-analysis revealed no difference of surgical accuracy between both sequencing,
with considerable heterogeneity. Conclusion: Mandible-first approach has been advocated under certain
indications, in order to reduce potential jaw repositioning error and ease of surgical manipulation. Differences
were not found in maxilla repositioning at central incisors, horizontally and vertically between both approaches.
However, the results should be taken with caution because of heterogeneity in study design and outcome
measurements. (Taiwanese Journal of Orthodontics. 31(1): 12-23, 2019)
Vol.31-1-3 March 2019
Use the Lip Bumper Appliance to Control the Lower Lip Biting Habit
Chun-Yu Chen,1,2 Chia-Tze Kao,1,2 Yu-Tin Wu,1,2 Chih-Chen Chou,1,2 Jui-Hsien Yang3
This is a 9 years old boy in mixed dentition stage, with Angle Class I malocclusion, anterior teeth crowding and proclined upper incisors. He was diagnosed with lower lip biting habit. The treatment plan was delivered with two stages treatment, stage 1 was to correct the lip biting habit by using the lip bumper. After four-month observation and lip training, the habit was corrected and the irregularity of lower dentition was decreased. Continued with stage 2 treatment, patient had upper and lower 2x4 fixed appliances to align and level the anterior teeth. The result showed the previous proclined upper incisors were moved palatally, and the lower incisors were moved labially after 3 months of treatment. The total treatment duration was 8 months.
Vol.31-1-4 March 2019
Management of Congenital Missing in Bilateral Mandibular Incisors
Yun-Ting Huang, Chien-Wei Chao, Po-Yu Yang, Chia-Tze Kao
This case report described the management of congenital missing bilateral mandibular central incisors in a 16 years-old female patient who was diagnosed as Angle’s Class I molar malocclusion, canine Class II relationship by a treatment plan of orthodontic space regain. The options of fixed bridge, removable partial denture or dental implants to replace the missing teeth were well explained to the patient by prosthodontic consultation. After the orthodontic alignment, the treatment results demonstrated that the initial profile of the patient was maintained, the missing teeth was later replaced by removable partial denture. The interdisciplinary therapy between orthodontics and prosthodontics should be addressed in cases with hypodontia.
Vol.31-1-5 March 2019
Orthodontic Correction of Transposed Maxillary Canine and First Premolar in Mixed Dentition
Lan-Tien Lin, Yi-Min Liu, Yuen-Yung Tsang
Transposition is rare and occurred commonly on maxillary canine and premolar. To extract or not to
extract, to correct or not to correct the dental transposition teeth, it’s a tough decision. A 12-year-old boy was
referred for orthodontic correction because of bad alignment at upper dentition. His dental age was in late
mixed dentition. Both upper deciduous canines were still retained. Left canine was buccally blocked-out, and
first premolar was in palatal crossbite with the lower premolars. Panoramic film showed impacted upper right
canine and transposed left canine and first premolar. The treatment duration took 3.5 years. The upper left
canine and the first premolar were aligned in correction of tooth position. In addition, the impacted upper
right canine was successfully exposed and aligned. The consideration of treatment plan should include factors
like positions of the crowns and roots, gingival line, smile esthetics, occlusal interferences and treatment
duration. It is important to avoid root interference and root resorption during tooth movement. Bucco-lingual
root inclination and soft tissue management should be addressed during correction of the dental transposition.
Vol.31-1-6 March 2019
The Orthodontic Treatment of Class III Malocclusion with Anterior Cross bite and Severe deep bite
Chieh Yang, Yu-Chuan Tseng
This 22-year-old female presents with skeletal Class III malocclusion, complicated by anterior cross bite, deep bite, and congenital missing of bilateral mandibular second premolars. The treatment modality was full-mouth fixed edgewise appliances. A favorable result of ideal overbite and overjet and closure of bilateral spaces of missing teeth were achieved. The patient was satisfied the improvement of function and esthetics after treatment.
Vol.30-4-1 December 2018
Orthodontic Treatment Management for Congenitally Missing Maxillary Lateral Incisors
Congenitally missing of maxillary lateral incisor is one of the most common agenesis anomalies. The purpose of this review was to present the orthodontic treatment of choice for a malocclusion with missing maxillary lateral incisors. Treatment plans consist of three categories: canine substitution, single-tooth implant and tooth supported restorations. Among which the least invasive option to achieve satisfying function and aesthetics is canine substitution.
Factors such as the profile of the patient, the space analysis of dentition, and the color and shape of canine should be taken into consideration for treatment choice.